The impact of opiate use disorder in patients with chronic medical conditions.

The Milliman Study

The Milliman group has produced a white paper (March 2019) that outlines the impacts of opiate use disorder in patients with chronic medical conditions, such as anemia, arthritis, back pain, kidney disease, diabetes, heart disease, hypertension, and others.  While these patients may ultimately become surgical patients, the focus was on the increased costs of taking care of these patients who have high opiate usage or those with diagnosed opiate use disorder (OUD). The cost of care in this report was $10.8 billion annually, broken down to $23,000 excess costs for OUD patients with chronic medical conditions and over $15,000 for those without chronic medical conditions.  High opiate users were not far behind, costing over $16,000 in excess costs for those with chronic medical conditions and nearly $10,000 for in excess costs for those without chronic medical conditions. Over 60 percent of patients on long term narcotics also met criteria for having at least one chronic medical condition. High opiate users were high utilizers of physical health services and pharmacy services (more than even those with OUD) but only came in at a lower excessive cost than the OUD patients due to their lack of use of behavioral health services.

Regardless of the surgical or medical treatment options that patients pursue, the costs of taking care of opiate-dependent patients remain extraordinarily high for both the insurance carrier and for our country at large. The White House estimate of direct and indirect costs related to opiate-dependent patients is just over $500 billion annually, which makes opiate-dependent patients a higher economic burden than historically challenging disease states such as diabetes ($327 Billion, American Diabetes Association, March 2018).  Finding cost-effective solutions is paramount to minimize the burden for insurance companies, patients, employers, and the government.   

Recent studies have shown that the costs and incidence of chronic opiate use is even higher in the Medicare population.